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Credit Card/Debit Authorization 2023
Please verify reCaptcha before submitting the form.
Please note: Each year you must complete a new form to be set-up for automatic payments.
Tuition will be paid up front at the time of registration unless there is a financial arrangement in place.
A processing fee of 3% will be added to all credit card transactions.
First Name
Last Name
Email Address
Name as it appears on credit card
Credit Card Number
Expiration Date
Security Code
ACH - Name on account
Bank Account #
Routing #
Frequency of Payment (Please select one)
Monthly
Quarterly
Semi-Annually
Check items that you would like your payments applied to
Bar/Bat Mitzvah
Building Fund
Dues
Endowment Fund
Security Assessment
Other Charges
Comments
Please check here in lieu of a signature
Please check here in lieu of a signature
Date of submission
Tue, May 13 2025 15 Iyyar 5785
